Disc Surgery Facts:

 

  • Indication for surgery is: progressive motor deficits, neurogenic bowel and bladder (cauda equina syndrome) and intractable pain. (3)

 

3. Postacchini F. Spine update: Results of surgical compared with conservative

management for lumbar disc herniations.

 

  • There is no data to support the premise that operative intervention will restore neurologic function more rapidly than natural history or non-operative intervention (39,55,63)

 

39. Weber H. The natural history of disc herniations and the influence of intervention.

Spine 1994;19:2234-8.

55. Weber H. Lumbar disc herniation: a controlled, prospective study with 10 years of

observation. Spine 1983;8:131-40.

63. Dubourg G, Rozenberg S, Fautrel B, et al. A pilot study on the recovery from paresis

after lumbar disc herniation. Spine 2002;27:1426-32

 

 

  • The surgical treatment of patients with discogenic pain without frank herniation has been limited to lumbar arthrodesis(aka: fusion), but this approach lacks consensus.28

 

28. Nachemson A, Zdeblick TA, O’Brien JP: Lumbar disc disease with discogenic

F. Todd Wetzel, MD, and Thomas A. McNally, MD Vol 11, No 1, January/February 2003 11

pain: What surgical treatment is most effective? Spine 1996;21:1835-1838.

 

 

  • In one retrospective series of 25 patients with positive discography (without Frank herniation) who refused surgery, 68% nonetheless improved.29

 

29. Smith SE, Darden BV, Rhyne AL, Wood KE: Outcome of unoperated discogrampositive

low back pain. Spine 1995;20: 1997-2001.

 

  • The efficacy of arthrodesis(aka: Fusion)  (without Frank herniation) is supported by other studies, with a rather wide range of success rates (39% to 96%).30-36

 

30. Colhoun E, McCall IW, Williams L, Cassar Pullicino VN: Provocation discography as a guide to planning operations on the spine. J Bone Joint Surg Br 1988;70:267-271.

31. Gill K, Blumenthal SL: Functional results after anterior lumbar fusion at L5-S1 in patients with normal and abnormal MRI scans. Spine 1992;17: 940-942.

32. Kozak JA, O’Brien JP: Simultaneous combined anterior and posterior fusion: An independent analysis of a treatment for the disabled low-back pain patient. Spine 1990; 15:322-328.

33. Newman MH, Grinstead GL: Anterior lumbar interbody fusion for internal disc disruption. Spine 1992;17:831-833.

34. Parker LM, Murrell SE, Boden SD, Horton WC: The outcome of posteriolateral fusion in highly selected patients with discogenic low back pain. Spine 1996;21:1909-1917.

35. Wetzel FT, LaRocca SH, Lowery GL, Aprill CN: The treatment of lumbar spinal pain syndromes diagnosed by discography: Lumbar arthrodesis. Spine 1994;19:792-800.

36. Zdeblick TA: A prospective, randomized study of lumbar fusion: Preliminary results. Spine 1993;18:983-991.

 

 

 

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